Utilization Review Nurse - Inpatient

This is a PRN position for an experienced UR RN with MCO experience.

Note: The training for this position is 4 weeks (remote) M-F. The hours once trained are Saturday & Sunday from 7:00 AM - 4:00 PM (Lunch from 12:00 PM - 1:00 PM).

As a PRN Utilization Review Registered Nurse you will be responsible for:

• All admissions assigned to your individual bin
• Monitoring of assigned department bin(s)
• Providing updates to the Medical Director at specified times
• Checking the on call mailbox as assigned bu the Inpatient UM Supervisor in the Friday emails

Ideally, you will need the following to be successful as a Utilization Review Nurse:

• Understanding of managed care delivery systems and utilization management
• Excellent verbal/written communication skills to effectively interact and work collectively with enrollees, physicians, facility staff and management staff
• Knowledge and expertise in utilizing various criteria sets (i.e. InterQual)
• Ability to negotiate and resolve conflicts with external customers.

We’d like you to have the following education/experience:

• Unencumbered Registered Nurse (RN) license in Maryland (or Compact RN licensure as applicable)
• 3+ years’ experience in Managed Care/Utilization Review in MCO is required
• 3+ years’ experience as an acute care RN
• BSN is preferred

This is a full-time, remote position. Weekend hours may be required as a part of your regular work schedule.

Who we are:

Johns Hopkins HealthCare (JHHC) is the managed care and health services business of Johns Hopkins Medicine. JHHC is a $3B business serving over 500,000 active members with lines of business in Medicaid, Medicare, commercial, military health, health solutions, and venture investments. JHHC is a leader in provider-sponsored health plans and is poised for future growth.

Many organizations talk about transforming the future of healthcare, at Johns Hopkins HealthCare, we are setting the pace for change within the healthcare industry. We develop innovative, analytics-driven health programs in collaboration with provider partners to drive improved quality and better health outcomes for our members and the communities we serve. If you are interested in improving how healthcare is delivered, and have a passion to be at the forefront of change, JHHC is the place to call home.

This position is eligible for remote work.

Johns Hopkins Health System and its affiliates are an Equal Opportunity / Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity and expression, age, national origin, mental or physical disability, genetic information, veteran status, or any other status protected by federal, state, or local law.

Johns Hopkins Health System and its affiliates are drug-free workplace employers.